Voting with their feet: what lessons can be learnt from increased consumption of public services in Uganda?

Uganda is a long way off achieving its Millennium Development Goals (MDGs). Persistently high child and maternal mortality reflect to some extent the poor performance of the health sector. The poor health service performance is itself a reflection of the chronic low expenditure on health and the inefficiency in the way in which resources are raised, allocated and managed. However, since 2000, there has been a small revolution in the health sector. Through sector wide approach, (SWAP) and the abolition of user fees, basic services have improved significantly and the use of public services has dramatically increased, as indicated by the doubling of outpatient attendances and immunization rates. The lesson learnt here is that a Government led SWAP can deliver significant social benefits. The budget support method is ultimately a more efficient way of financing social services than project funding or user fees. Investment in SWAP and sector targeted technical assistance in addition to budget support are the critical factors in the health sector revolution

Investigating the Origin of Observed Central Dips in Radial Metallicity Profiles

Radial metallicity trends provide a key indicator of physical processes such as star formation and radial gas migration within a galaxy. Large IFU surveys allow for detailed studies of these radial variations, with recent observations detecting central dips in the metallicity, which may trace the impact of various evolutionary processes. However, the origin of these dips has not been conclusively determined, with suggestions that they may be diagnostic dependent. In this paper, we use the SDSS-IV MaNGA survey to investigate whether the observed dips represent genuine decreases in the central metallicity, or if they could be an artefact of the diagnostic used. Using a sub-sample of 758 local star-forming galaxies at low inclinations, we investigate in detail the impact of using different strong line diagnostics on the shapes of the returned profiles, and the prevalence of dips. We find no clear evidence of the dips being caused by changing values of the ionisation parameter within galaxies. To investigate physical causes, we explore both global and spatially-resolved parameters, finding that galaxies exhibiting central dips in the O3N2 metallicity profile have on average lower H$\alpha$EW values out to R/R_\rm{e} \sim 1.5, and higher values of D$_N$(4000) in the central regions. We additionally find a higher prevalence of dips in galaxies with high stellar mass, and lower values of global specific star formation rate, suggesting a possible link to central quenching. Nevertheless, these results are dependent on the diagnostic used, suggesting caution should be taken when interpreting observed features in galaxy metallicity gradients.Comment: Accepted for publication in MNRAS. 23 pages; 21 figure

Understanding the Slow Depletion of Memory CD4+ T Cells in HIV Infection

Using a simple mathematical model, Andrew Yates and colleagues show that a runaway cycle of T cell activation and infection cannot explain the slow rate of CD4 decline during chronic HIV infection

L-galaxies 2020: Spatially resolved cold gas phases, star formation and chemical enrichment in galactic discs

© 2023 Oxford University Press. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1093/mnras/stz3233We have updated the Munich galaxy formation model, L-Galaxies, to follow the radial distributions of stars and atomic and molecular gas in galaxy discs. We include an H2-based star-formation law, as well as a detailed chemical-enrichment model with explicit mass-dependent delay times for SN-II, SN-Ia and AGB stars. Information about the star formation, feedback and chemical-enrichment histories of discs is stored in 12 concentric rings. The new model retains the success of its predecessor in reproducing the observed evolution of the galaxy population, in particular, stellar mass functions and passive fractions over the redshift range 0Peer reviewe

Threats to seabirds: A global assessment

We present the first objective quantitative assessment of the threats to all 359 species of seabirds, identify the main challenges facing them, and outline priority actions for their conservation. We applied the standardised Threats Classification Scheme developed for the IUCN Red List to objectively assess threats to each species and analysed the data according to global IUCN threat status, taxonomic group, and primary foraging habitat (coastal or pelagic). The top three threats to seabirds in terms of number of species affected and average impact are: invasive alien species, affecting 165 species across all the most threatened groups; bycatch in fisheries, affecting fewer species (100) but with the greatest average impact; and climate change/severe weather, affecting 96 species. Overfishing, hunting/trapping and disturbance were also identified as major threats to seabirds. Reversing the top three threats alone would benefit two-thirds of all species and c. 380 million individual seabirds (c. 45% of the total global seabird population). Most seabirds (c. 70%), especially globally threatened species, face multiple threats. For albatrosses, petrels and penguins in particular (the three most threatened groups of seabirds), it is essential to tackle both terrestrial and marine threats to reverse declines. As the negative effects of climate change are harder to mitigate, it is vital to compensate by addressing other major threats that often affect the same species, such as invasive alien species, bycatch and overfishing, for which proven solutions exist

Evaluating a multicomponent survivorship programme for men with prostate cancer in Australia: A single cohort study

Objective: To evaluate the implementation of a multicomponent survivorship programme for men with prostate cancer and their carers. Design: A single cohort study, guided by the RE-AIM framework. Setting: Multiple health services in Australia. Participants: Men with prostate cancer and their carers, and health professionals. Intervention: A 12-month telehealth programme that provided centralised and coordinated decision and information support, exercise and nutrition management, specialised clinical support and practical support to men and their carers. Data collection: Multiple sources of data including participant-reported health outcomes and experience of care, qualitative interviews, records of the programme were collected at different time points. Results: Reach: Of 394 eligible men at various stages of survivorship, 142 consented (36% consent rate) and 136 (96%) completed the programme. Adoption: All men participated in general care coordination and more than half participated in exercise and/or nutrition management interventions. Participation in the specialised support component (ie, psychosocial and sexual health support, continence management) was low despite the high level of need reported by men. Effectiveness: Overall, the men reported improvements in their experience of care. Implementation: Factors such as addressing service gaps, provision of specialised services, care coordination, adoption of needs-based and telehealth-based approaches were identified as enablers to the successful implementation of the programme. Issues such as insufficient integration with existing services, lack of resources and high caseload of the intervention team, men\u27s reluctance to discuss needs and lack of confidence with technology were barriers in implementing the programme. Conclusion: Survivorship interventions are relevant to men regardless of the stage of their disease and treatments undertaken. It is possible to provide access to a comprehensive model of survivorship care to promote the health and quality of life for men with prostate cancer. Trial registration number: This study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000174381)

An integrated multicomponent care model for men affected by prostate cancer: A feasibility study of TrueNTH Australia

Objective: To evaluate the feasibility of implementing an integrated multicomponent survivorship care model for men affected by prostate cancer. Methods: Using a single arm prospective cohort study design, men with prostate cancer were recruited from two regional public hospitals in Australia for a 6-months program that provided information and decision support, exercise and nutrition management, specialised clinical support, and practical support through localised and central care coordination. Carers of the men were also invited to the program. Data were collected from multiple sources to evaluate: (1) recruitment capability and participant characteristics; (2) appropriateness and feasibility of delivering the specific intervention components using an electronic care management tool; and (3) suitability of data collection procedures and proposed outcome measures. Results: Of the 105 eligible men, 51 (consent rate 49%) participated in the program. Of the 31 carers nominated by the men, 13 consented (consent rate 42%). All carers and 50 (98%) men completed the program. Most (92%) men were newly diagnosed with localised prostate cancer. All men attended initial screening and assessment for supportive care needs; a total of 838 episodes of contact/consultation were made by the intervention team either in person (9%) or remotely (91%). The intervention was implemented as proposed with no adverse events. The proposed outcome measures and evaluation procedures were found to be appropriate. Conclusions: Our results support the feasibility of implementing this integrated multicomponent care model for men affected by prostate cancer

Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries

Background The COVID-19 pandemic was a health emergency requiring rapid scal resource mobilisation to support national responses. The use of e ective health nancing mechanisms and policies, or lack thereof, a ected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health nancing policies adopted in 15 countries during the pandemic, develop a framework for resilient health nancing, and use this pandemic to argue a case to move towards universal health coverage (UHC). Methods In this case study, we examined the national health nancing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health nancing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health nancing. Findings Resilient health nancing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain scal space for health to move towards UHC while building on resilient health nancing structures that can better prepare health systems for future health emergencies. We observed that ve key nancing policies were implemented across the countries— namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, e cient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure e cient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. Interpretation Our ndings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health nancing policies robust and need to politically commit to public nancing mechanisms that work to prepare for future emergencies and as a lever for UHC.We thank the management team of the Bill & Melinda Gates Foundation and the Saw Swee Hock School of Public Health (National University of Singapore, Singapore) for all the administrative support given. This research was funded by the Bill & Melinda Gates Foundation (Investment ID INV-005598)